Journal Article•
Evaluation of fasting and random plasma glucose for diagnosis of gestational diabetes.
01 Nov 2009-Jcpsp-journal of The College of Physicians and Surgeons Pakistan (J Coll Physicians Surg Pak)-Vol. 19, Iss: 11, pp 718-722
TL;DR: Fasting plasma glucose is a better investigation for the screening of gestational diabetes than plasma glucose post 50-g glucose challenge.
Abstract: OBJECTIVE To compare different cut-off values of fasting and random plasma glucose as a screening test for diagnosis of gestational diabetes in comparison to the 50 grams Glucose Challenge Test (GCT). STUDY DESIGN Comparative, cross-sectional study. PLACE AND DURATION OF STUDY This study was carried out between July 2006 to September 2007 at Departments of Pathology, Obstetrics/Gynaecology and Medicine, PNS Rahat Hospital, Karachi. METHODOLOGY A total of 53 pregnant subjects at 24-28 weeks of pregnancy were selected to undergo random and fasting blood sugar level estimation and 50-g GCT. All the subjects later underwent 100-g OGTT as well. The results were evaluated by both "Carpenter and Coustan criteria" and "NDDG criteria". The results of random plasma glucose random [cut-off: > or = 11.1 mmol/L], fasting plasma glucose (cut-off: > 5.3 mmol/L and > 5.1 mmol/L) and plasma glucose results post 50-g GCT (cut-off: > or =7.8 mmol/L and > or = 7.2 mmol/L) were evaluated against 100-g OGTT results through ROC curve analysis. Finally, various diagnostic parameters including sensitivity, specificity, predictive values, likelihood ratios (LR) and efficiency were evaluated. RESULTS Nineteen subjects were diagnosed to have GDM as per the "Carpenter and Coustan criteria" and 13 met the "NDDG criteria" as per the results of 100-g OGTT. Fasting plasma glucose at was the most efficient investigation at cutoff of 5.1 mmol/L sensitivity=66.66%, specificity=81.25%, PPV=70%, NPV=78.78%, LR+=3.56, LR-=0.41, efficiency=75.47%. At the cut-off value of 5.3 mmol/L, the results had 64% sensitivity, 85.71% specificity, 80% PPV, 72.72% NPV, 4.48 LR+, 0.42 LR-, 75.97% efficiency]. It was followed by plasma glucose post 50-g GCT (53.57% sensitivity at cut-off of > or = 7.2 mmol/L and 54.54% sensitivity at cut-off of > or = 7.8 mmol/L). CONCLUSION Fasting plasma glucose is a better investigation for the screening of gestational diabetes than plasma glucose post 50-g glucose challenge.
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TL;DR: It was deemed essential to develop an appropriate, uniform terminology and a functional, working classification of diabetes that reflects the current knowledge about the disease.
Abstract: the growth of knowledge regarding the etiology and pathogenesis of diabetes has led many individuals and groups in the diabetes community to express the need for a revision of the nomenclature, diagnostic criteria, and classification of diabetes. As a consequence, it was deemed essential to develop an appropriate, uniform terminology and a functional, working classification of diabetes that reflects the current knowledge about the disease. (1)
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TL;DR: The clinical detection of Gestational diabetes mellitus (GDM) is accomplished in different ways in different countries as mentioned in this paper, in which the approaches apply one or more of the following procedures: clinical risk assessment, glucose tolerance screening, and formal glucose tolerance testing.
Abstract: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. As such, GDM is the product of routine glucose tolerance screening that is currently carried out in otherwise healthy individuals. Like other forms of hyperglycemia, GDM is characterized by pancreatic β-cell function that is insufficient to meet the body's insulin needs. Available evidence suggests that β-cell defects in GDM result from the same spectrum of causes that underlie hyperglycemia in general, including autoimmune disease, monogenic causes, and insulin resistance. Thus, GDM often represents diabetes in evolution and, as such, holds great potential as a condition in which to study the pathogenesis of diabetes and to develop and test strategies for diabetes prevention.
The clinical detection of GDM is accomplished in different ways in different countries. In general, the approaches apply one or more of the following procedures: 1 ) clinical risk assessment, 2 ) glucose tolerance screening, and 3 ) formal glucose tolerance testing. The procedures are applied to pregnant women not already known to have diabetes. Controversies regarding the optimal methods for detecting GDM are beyond the scope of this article. The relevant point is that the screening for GDM is the only standard medical practice that applies screening for glucose intolerance to otherwise healthy individuals. Regardless of the glucose thresholds that are used to diagnose GDM, the patients are relatively young individuals whose glucose levels are in the upper end of the population distribution during pregnancy. A small minority of those women have glucose levels that would be diagnostic of diabetes outside of pregnancy. The large majority have lower glucose levels when they are diagnosed with GDM, but they are at high risk for developing diabetes after pregnancy. Together, patients with GDM offer an important opportunity to study the evolution of diabetes and to develop, …
319 citations
TL;DR: This thesis aims to evaluate costs and effects of various screening strategies in order to obtain a uniform (cost-)effective strategy for detection of gestational diabetes.
Abstract: OBJECTIVE The purpose of this document is to briefly review the existing data regarding the effect of a diagnosis of gestational diabetes mellitus (GDM), the different screening and diagnostic practices for GDM, and, finally, outline the recommended options for GDM screening in Canada. OPTIONS Consideration has been given to the existing screening practices for GDM including universal screening, risk factor-based screening, and the option of not screening for GDM. OUTCOMES The short- and long-term maternal-fetal outcomes in GDM were reviewed with emphasis given to examination of the data regarding the effect of diagnosis and treatment of GDM on these outcomes. EVIDENCE A comprehensive search of the literature from 1990 through April 2002 using MEDLINE and the Cochrane Database and a review of randomized controlled trials (RCTs) was undertaken. Additional studies and clinical guidelines published outside this time frame but with specific clinical relevance were also reviewed. The level of evidence of the recommendations in this document has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS I. A single approach of testing for GDM cannot be recommended at the present as there is not enough evidence-based data proving the beneficial effect of a large screening program. Until a large prospective RCT shows a clear clinical benefit for screening and consequently treating GDM, recommendations will by necessity be based on consensus or expert opinion. Each of the following approaches is acceptable. a. Routine screening of women at 24-28 weeks of gestation may be recommended with the 50 g glucose challenge test (GCT), using a threshold of 7.8 mmol/L (140 mg/dL), except in those women who fulfill the criteria for low risk, which includes the following: * maternal age < 25 * Caucasian or member of other ethnic group with low prevalence of diabetes * pregnant body mass index (BMI)
204 citations
TL;DR: A prospective, randomized study compared a risk factor‐based screening programme with a universally based one for Gestational diabetes mellitus and found the latter to be more effective.
Abstract: Summary
Aims Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcome. Screening for GDM is therefore recommended but the best screening method remains controversial. This prospective, randomized study compared a risk factor-based screening programme with a universally based one.
Methods Subjects were randomized at booking to one of two groups: the risk factor group had a 3-h 100-g oral glucose tolerance test (OGTT) at 32 weeks if any risk factor for GDM was present; the universal group had a 50-g glucose challenge test performed and if their plasma glucose at 1 h was ≥ 7.8 mmol/l, a formal 3-h 100-g OGTT was then performed.
Results Universal screening detected a prevalence of GDM of 2.7%, significantly more than the 1.45% detected in the risk factor screened group (P < 0.03). Universal screening facilitated earlier diagnosis than risk factor screening – mean gestation 30 ± 2.6 weeks vs. 33 ± 3.7 weeks (P < 0.05). A higher rate of spontaneous vaginal delivery at term, and lower rates of macrosomia, Caesarean section, prematurity, pre-eclampsia and admission to neonatal intensive care unit were observed in the universally screened, early diagnosis group.
Conclusions Universal screening for GDM is superior to risk factor based screening – detecting more cases, facilitating early diagnosis and is associated with improved pregnancy outcome.
175 citations